AB0529 GLUCOCORTICOIDS WITHDRAWN IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT STATE: A DESIRABLE GOAL
Authors: D. Yufang, J. Zhao, Q. Wang, X. Tian, M. LI, X. Zeng
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Serologically active clinically quiescent (SACQ) is a clinical state of systemic lupus erythematosus (SLE) characterized by high levels of serologic markers without clinical activity. The outcome and treatment strategy after SACQ achievement remains unclear. After achieving the treatment goal, maintaining low-dose glucocorticoids has always been both a blessing and a curse <sup>[1,2]</sup>. Whether glucocorticoids discontinuation is a desirable goal in patients achieved SACQ was controversial. <h3>Objectives</h3> In this multi-center prospective study, we aimed to identify the risk of flares, organ damage accumulation, and the low-dose glucocorticoids discontinuation feasibility of SLE patients who achieved the clinical state as SACQ. <h3>Methods</h3> This observational study was conducted based on data from the Chinese SLE treatment and research (CSTAR) registry. Demographic characteristics, autoantibody profiles, clinical manifestations, disease activity status, organ damage, and treatment profile were collected at recruitment and during follow-up. SACQ was defined as at least a 6-months period with persistent serologic activity (positive anti-dsDNA antibody, and/or hypocomplementemia), and without clinical activity. Serologically quiescent clinically quiescent (SQCQ) was defined as at least a 6-months period without serologic or clinical activity. The flare was measured according to the SELENA-SLEDAI flare index (SFI). Organ damage is principally assessed using the SLICC damage index (SDI). <h3>Results</h3> Of 4107 SLE patients, 1889 reached the clinical quiescent stage (990 achieved the clinical state as SACQ, and 899 patients achieved SQCQ). Among 990 SACQ patients, 364 (36.7%) underwent flares, 163(16.5%) showed organ damage, 47 (4.7%) developed renal damage, and 21 (2.1%) died during a mean follow-up of 7.30 years. Compared with patients who achieved SQCQ, SACQ patients were at a higher risk of flares (HR=1.47, 95% CI 1.25-1.73,p&lt;0.001) and renal damage accumulation (HR=2.02, 95% CI 1.23-3.33, p=0.004). Furthermore, 224 (22.6%) SACQ patients withdraw low-dose glucocorticoids and 125 (55.8%) of them did not flare during follow-up. Low-dose glucocorticoids discontinuation was a favorable factor of long-term survival (HR=0.22, 85% CI, 0.05-0.96, P=0.044). As shown in the Figure 1, withdrawing glucocorticoids can reduce organ damage (p=0.0075), especially renal damage accumulation (p=0.045), even experience flares after discontinuation. (A) (B) <h3>Conclusion</h3> Our results suggest that low-dose glucocorticoids withdrawal under tight survallance could be considered after achieving the clinical state as SACQ to prevent the accrual of renal damage. <h3>References</h3> [1]Apostolopoulos D, et al. The Lancet Rheumatology 2020;2(1):e24-e30. [2]Mathian A, et al. Ann Rheum Dis 2020;79(3):339-46. <h3>Acknowledgements</h3> We thank CSTAR co-authors as following for assistance with cases collections. <h3>Disclosure of Interests</h3> None Declared.